Provider Demographics
NPI:1770783698
Name:BRISSON, MELISSA RENEE (LPN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:RENEE
Last Name:BRISSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2448 COUNTY ROAD 57 W
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43324-9731
Mailing Address - Country:US
Mailing Address - Phone:937-592-9099
Mailing Address - Fax:
Practice Address - Street 1:2448 COUNTY ROAD 57 W
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43324-9731
Practice Address - Country:US
Practice Address - Phone:937-592-9099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 105477164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse